Brain parenchymal changes due to longstanding effects of untreated or poorly treated systemic HTN
CHE is most common cause of leukoaraiosis [diffuse rarefaction of white matter (WM)]
Others include diabetes
CHE: Important cause of cognitive deficits caused by vascular disease (i.e., vascular dementia)
IMAGING
General Features
CT Findings
MR Findings
Ultrasonographic Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Wang Y et al: Intracranial atherosclerotic disease. Neurobiol Dis. 124:118-32, 2019
Carnevale L et al: Brain MRI fiber-tracking reveals white matter alterations in hypertensive patients without damage at conventional neuroimaging. Cardiovasc Res. 114(11):1536-46, 2018
Haller S et al: Cerebral microbleeds: imaging and clinical significance. Radiology. 287(1):11-28, 2018
Regenhardt RW et al: Advances in understanding the pathophysiology of lacunar stroke: a review. JAMA Neurol. 75(10):1273-81, 2018
Rosenberg GA: Binswanger's disease: biomarkers in the inflammatory form of vascular cognitive impairment and dementia. J Neurochem. 144(5):634-43, 2018
Pu Y et al: Intracranial atherosclerosis: from anatomy to pathophysiology. Int J Stroke. 12(3):236-45, 2017
Suzuki H et al: Abnormal brain white matter microstructure is associated with both pre-hypertension and hypertension. PLoS One. 12(11):e0187600, 2017
Prins ND et al: White matter hyperintensities, cognitive impairment and dementia: an update. Nat Rev Neurol. 11(3):157-65, 2015
van Dalen JW et al: Cortical microinfarcts detected in vivo on 3 Tesla MRI: clinical and radiological correlates. Stroke. 46(1):255-7, 2015
Marsh EB et al: Predicting symptomatic intracerebral hemorrhage versus lacunar disease in patients with longstanding hypertension. Stroke. 45(6):1679-83, 2014
Ritz K et al: Cause and mechanisms of intracranial atherosclerosis. Circulation. 130(16):1407-14, 2014
Cheng AL et al: Susceptibility-weighted imaging is more reliable than T2*-weighted gradient-recalled echo MRI for detecting microbleeds. Stroke. 44(10):2782-6, 2013
Wardlaw JM et al: Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. Lancet Neurol. 12(5):483-97, 2013
Bastos-Leite AJ et al: Cerebral blood flow by using pulsed arterial spin-labeling in elderly subjects with white matter hyperintensities. AJNR Am J Neuroradiol. 29(7):1296-301, 2008
Della Nave R et al: Whole-brain histogram and voxel-based analyses of diffusion tensor imaging in patients with leukoaraiosis: correlation with motor and cognitive impairment. AJNR Am J Neuroradiol. 28(7):1313-9, 2007
O'Sullivan M et al: Diffusion tensor MRI correlates with executive dysfunction in patients with ischaemic leukoaraiosis. J Neurol Neurosurg Psychiatry. 75(3):441-7, 2004
Wardlaw JM et al: Is breakdown of the blood-brain barrier responsible for lacunar stroke, leukoaraiosis, and dementia? Stroke. 34(3):806-12, 2003
Catani M et al: Proton magnetic resonance spectroscopy reveals similar white matter biochemical changes in patients with chronic hypertension and early Alzheimer's disease. J Am Geriatr Soc. 50(10):1707-10, 2002
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Abbreviations
Chronic hypertensive encephalopathy (CHE)
Synonyms
Subcortical arteriosclerotic encephalopathy
a.k.a. Binswanger disease
Hypertension (HTN)-related microvascular disease
Hypertensive microangiopathy
Definitions
Brain parenchymal changes due to longstanding effects of untreated or poorly treated systemic HTN
CHE is most common cause of leukoaraiosis [diffuse rarefaction of white matter (WM)]
Others include diabetes
CHE: Important cause of cognitive deficits caused by vascular disease (i.e., vascular dementia)
IMAGING
General Features
CT Findings
MR Findings
Ultrasonographic Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Wang Y et al: Intracranial atherosclerotic disease. Neurobiol Dis. 124:118-32, 2019
Carnevale L et al: Brain MRI fiber-tracking reveals white matter alterations in hypertensive patients without damage at conventional neuroimaging. Cardiovasc Res. 114(11):1536-46, 2018
Haller S et al: Cerebral microbleeds: imaging and clinical significance. Radiology. 287(1):11-28, 2018
Regenhardt RW et al: Advances in understanding the pathophysiology of lacunar stroke: a review. JAMA Neurol. 75(10):1273-81, 2018
Rosenberg GA: Binswanger's disease: biomarkers in the inflammatory form of vascular cognitive impairment and dementia. J Neurochem. 144(5):634-43, 2018
Pu Y et al: Intracranial atherosclerosis: from anatomy to pathophysiology. Int J Stroke. 12(3):236-45, 2017
Suzuki H et al: Abnormal brain white matter microstructure is associated with both pre-hypertension and hypertension. PLoS One. 12(11):e0187600, 2017
Prins ND et al: White matter hyperintensities, cognitive impairment and dementia: an update. Nat Rev Neurol. 11(3):157-65, 2015
van Dalen JW et al: Cortical microinfarcts detected in vivo on 3 Tesla MRI: clinical and radiological correlates. Stroke. 46(1):255-7, 2015
Marsh EB et al: Predicting symptomatic intracerebral hemorrhage versus lacunar disease in patients with longstanding hypertension. Stroke. 45(6):1679-83, 2014
Ritz K et al: Cause and mechanisms of intracranial atherosclerosis. Circulation. 130(16):1407-14, 2014
Cheng AL et al: Susceptibility-weighted imaging is more reliable than T2*-weighted gradient-recalled echo MRI for detecting microbleeds. Stroke. 44(10):2782-6, 2013
Wardlaw JM et al: Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. Lancet Neurol. 12(5):483-97, 2013
Bastos-Leite AJ et al: Cerebral blood flow by using pulsed arterial spin-labeling in elderly subjects with white matter hyperintensities. AJNR Am J Neuroradiol. 29(7):1296-301, 2008
Della Nave R et al: Whole-brain histogram and voxel-based analyses of diffusion tensor imaging in patients with leukoaraiosis: correlation with motor and cognitive impairment. AJNR Am J Neuroradiol. 28(7):1313-9, 2007
O'Sullivan M et al: Diffusion tensor MRI correlates with executive dysfunction in patients with ischaemic leukoaraiosis. J Neurol Neurosurg Psychiatry. 75(3):441-7, 2004
Wardlaw JM et al: Is breakdown of the blood-brain barrier responsible for lacunar stroke, leukoaraiosis, and dementia? Stroke. 34(3):806-12, 2003
Catani M et al: Proton magnetic resonance spectroscopy reveals similar white matter biochemical changes in patients with chronic hypertension and early Alzheimer's disease. J Am Geriatr Soc. 50(10):1707-10, 2002
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